Obese kidney transplant recipients have good outcomes

Howard, Richard J.; Thai, Van B.; Patton, Pamela R.; Hemming, Alan W.; Reed, Alan; Werf, Willem J. Van der; Fujita, Shiro; Karlix, Janet L.; Scornik, Juan C.

doi:10.1016/s0041-1345(01)02474-5

Cited by 28 publications

(9 citation statements)

References 6 publications

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“…Surgical complications and wound infections were not significantly different between the 2 groups, which is unlike the experience at other centers [32, 33]. …”

Section: Discussioncontrasting

confidence: 59%

The Effects of Body Mass Index on Graft Survival in Adult Recipients Transplanted with Single Pediatric Kidneys

et al. 2008

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Background: There is insufficient data on the impact of recipient body mass index (BMI) on the long-term graft survival of adult patients transplanted with single pediatric kidneys. Methods: We performed a retrospective analysis of adult patients transplanted with single pediatric kidneys at our center. The recipients were classified into 2 groups: group 1 (BMI ≥30) and group 2 (BMI <30). Donor/recipient demographics, postoperative outcomes and survival rates were compared between the 2 groups. Results: There was no significant difference in donor/recipient demographics between the 2 groups. In group 1, the death-censored graft survival (DCGS) at 1, 3 and 5 years was 90% at all 3 time points, and in group 2 it was 86, 68 and 60%, respectively (p = 0.05). The mean glomerular filtration rate (with standard deviation in parentheses) at 1, 3 and 5 years was, respectively, 55 (15), 59 (19) and 55 (28) ml/min for group 1, compared to 65 (28), 69 (23) and 67 (20) ml/min in group 2 (p = NS). Multivariate analysis revealed a hazard ratio of 5.12 (95% confidence interval 1.06–24.7; p = 0.04) for graft loss in nonobese patients when compared to obese patients. Obese patients had an increased risk for acute rejections within the first month of transplant (p = 0.02). Conclusion: Patients with a BMI ≥30 transplanted with single pediatric kidneys have better DCGS rates when compared to nonobese patients.

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“…Surgical complications and wound infections were not significantly different between the 2 groups, which is unlike the experience at other centers [32, 33]. …”

Section: Discussioncontrasting

confidence: 59%

The Effects of Body Mass Index on Graft Survival in Adult Recipients Transplanted with Single Pediatric Kidneys

et al. 2008

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“…Longer total operating times and prolonged revascularization have both been implicated 28,29 . In contrast, an equal number of similar sized studies carried out during the last decade reported no such association between obesity and DGF 18,30 , 31 . One may postulate that improving surgical techniques and a shorter revascularization period might account in part for these findings, although definitive evidence for this is currently lacking.…”

Section: Pretransplant Obesity: Complications and Outcomesmentioning

confidence: 99%

“…28,29 In contrast, an equal number of similar sized studies carried out during the last decade reported no such association between obesity and DGF. 18,30,31 One may postulate that improving surgical techniques and a shorter revascularization period might account in part for these findings, although definitive evidence for this is currently lacking. In summary, evidence from the current literature is conflicting, but obesity may predispose the recipient to DGF, particularly at the more extreme end of the spectrum (i.e.…”

Section: Delayed Graft Functionmentioning

confidence: 99%

Impact of obesity on renal transplant outcomes

et al. 2005

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SUMMARY:Obesity is a frequent and important consideration to be taken into account when assessing patient suitability for renal transplantation. In addition, posttransplant obesity continues to represent a significant challenge to health care professionals caring for renal transplant recipients. Despite the vast amount of evidence that exists on the effect of pretransplant obesity on renal transplant outcomes, there are still conflicting views regarding whether obese renal transplant recipients have a worse outcome, in terms of short-and long-term graft survival and patient survival, compared with their non-obese counterparts. It is well established that any association of obesity with reduced patient survival in renal transplant recipients is mediated in part by its clustering with traditional cardiovascular risk factors such as hypertension, dyslipidaemia, insulin resistance and posttransplant diabetes mellitus, but what is not understood is what mediates the association of obesity with graft failure. Whether it is the higher incidence of cardiovascular comorbidities jeopardising the graft or factors specific to obesity, such as hyperfiltration and glomerulopathy, that might be implicated, currently remains unknown. It can be concluded, however, that pre-and posttransplant obesity should be targeted as aggressively as the more well-established cardiovascular risk factors in order to optimize long-term renal transplant outcomes. KEY WORDS: cardiovascular risk factors, graft function, obesity, renal transplant recipients, transplant outcomes.The World Health Organization (WHO) classification of obesity is determined by the body mass index (BMI), which is defined as weight in kilograms (kg) divided by height in metres squared (m 2 ). Using this calculation, a BMI of 18.5-24.9 kg/m 2 represents normal weight, a BMI of 25-29.9 kg/m 2 represents overweight, and a BMI greater than 30 kg/m 2 represents obesity.

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“…One of the factors could be ectopic perivascular fat storage and its related paracrine function, local higher oxidative stress and inflammation (Reese et al 2009). Obese kidney transplant recipients exhibit increased delayed graft function, increased immunologic graft loss, decreased graft survival, decreased patient survival and increased post-transplant complications (Howard et al 2001). Diet-induced fat deposition in experimental models of obesity is not limited to subcutaneous fat and classical visceral depots; it also occurs along the major blood vessels (Dwyer et al 1995).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Ectopic Fat on Graft Function After Living Kidney Transplantation

Thieme

Janoušek²,

Froněk³

et al. 2015

Physiol Res

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Renal transplantation is associated with a large number of risk factors that can have an influence on early renal graft function (ERGF). One of these factors could be the increasing number of obese kidney donors. The mechanisms of reduced ERGF in obese kidney donors are still poorly understood. To that end, we compared ERGF in recipients with body mass index (BMI), perivascular fat and plasma inflammation markers of live kidney donors. We hypothesized that the BMI of donors would negatively correlate with an average increase of glomerular filtration rate (GFR) and that it would also be associated with increased perivascular and plasma inflammation markers in the first seven days after transplantation. Between January 2013 and December 2014, some 58 living kidney transplantation pairs were included in the study. Donor and recipient demographic data, preoperative BMI, blood C-reactive protein (CRP) and adiponectin levels, perivascular adipose tissue (PAT) samples and recipient blood creatinine levels were analyzed. The median CRP of donors was 0.68 mg/l (max: 8.66 mg/l, min: 0.33 mg/l), the median of M1 macrophages (CD14+CD16+) in one gram of PAT was 5940 (max: 41 100, min: 248) and the median of adiponectin was 411 930 pg/ml (max: 14 217 000, min: 167 300) in plasma. We did not find any association between early renal graft function and the percentage of M1 macrophages in donor perirenal adipose tissue (p=0.83, r=0.03, n=58), adiponectin (p=0.65, r=0.06, n=58) or CRP (p=0.16, r=0.2, n=58) in plasma. The obesity level of donors, expressed as BMI, did not correlate with early renal graft function in the first seven days after transplantation. The associations between ERGF and plasma and perivascular fat inflammation markers were not significant. We confirmed a negative correlation between the BMI of recipients and an average increase of GFR in the first seven days after transplantation (p<0.02, r=-0.325, N=58). We confirmed a negative correlation of adiponectin plasma concentration to the BMI of donors.

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Obese kidney transplant recipients have good outcomes

Cited by 28 publications

References 6 publications

The Effects of Body Mass Index on Graft Survival in Adult Recipients Transplanted with Single Pediatric Kidneys

The Effects of Body Mass Index on Graft Survival in Adult Recipients Transplanted with Single Pediatric Kidneys

Impact of obesity on renal transplant outcomes

The Effect of Ectopic Fat on Graft Function After Living Kidney Transplantation

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